Figure 1
Axial T1W SE before (a-b) and after (c-d) Gd IV
Clinical History
Large tumour of the maxillary sinus and ethmoid with nasal
bleeding, proptosis, and facial hypoesthesia
Imaging Findings
This patient complaints of nasal obstruction, epistaxis,
proptosis and right hemifacial hypoesthesy. ENT examination
shows a right nasal tumour.
MRI is performed with pre- and post contrast sequences and
different spatial resolutions.
The relevant questions to answer to are:
What about the upper limits of the lesion?
How may you explain the high signal in the right maxillary
sinus on the T1 pre-contrast images?
Describe and explain the signal characteristics of the
lesion.
Discussion
The following sequences were used:
T2w FSE coronal
T1w SE axial and coronal pre- and post-Gd DOTA
This tumour, centred on the ethmoid extends to the anterior
skull base and anterior cranial fossa, with brain
infiltration, to the right orbit, the right maxillary sinus.
The T1 high signal is due to proteinaceous viscous contents
of the retention material.
The tumour before contrast appears heterogeneous due to
combined necrosis and haemorrhages (see the necrotic areas
appearing hypersignal on T2w images). Another explanation
for high signal areas on T1 is retention of mucous
substances in tumour.
The histology showed a glandular epithelioma of the right maxillary sinus.
The patient was treated with surgery and radiotherapy, unfortunately the disease evolved and he died a few months later.
Differential Diagnosis List
Glandular epithelioma of the maxillary sinus
Final Diagnosis
Glandular epithelioma of the maxillary sinus
Case information
| URL: | https://eurorad.org/case/72 |
| DOI: | 10.1594/EURORAD/CASE.72 |
| ISSN: | 1563-4086 |
Figure 2
Coronal T1W SE before (a-b) and after (c) Gd IV
Note the high signal areas in the tumour
There is high signal material in the outer part of the right maxillary sinus corresponding to retention changes. Note also inflammatory changes in the left maxillary sinus.
Contrast enhancement helps to show the extent of the tumour infiltration in the anterior skull base.
Axial T1W SE before (a-b) and after (c-d) Gd IV
Coronal T1W SE before (a-b) and after (c) Gd IV
Note the high signal areas in the tumour
There is high signal material in the outer part of the right maxillary sinus corresponding to retention changes. Note also inflammatory changes in the left maxillary sinus.
Contrast enhancement helps to show the extent of the tumour infiltration in the anterior skull base.
